HomeMy WebLinkAboutPermit Electrical 2005-11-17
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (54r>726~368~,_"f!~i!~l~
ELECTRICAL PERMIT APPLICATION .I '.:.: i'.' .
City Job Number CoIl12005.. 0 Ih '1.../ Dat~"lfrI7ft/S
,
JOB DESCRIPTION
J&cc/VLLef OY1~
~ermits are non-traD~ferable and e'fpire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2.
Electrical Contractor ~ e~L
Address \9\0 0 28n-\ S;:T ~
City~ ri06 Vtt;lb Phone '14-7-22J3
Supervisor License Number 2..<:t3 w S
Expiration Date \ D -l .... 2or:J7
Constr. Contr. Number \ 2,,1'2,
Expiration Date S- ".., Z ?. ~ 0'1
Signature of Supervising Electrician
~ iLL 1k ffil1tt-a -
/ cY ~- (\
Owners Name L,loLfd lfA.htl
Address tQ/:1 ~~r~ '
City Sf r"YVtfi~It:fPhone ""~7'" U..J 8
J 'U;~
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
3.
A.
Service Included
1000 sq, ft. or less
Each additional 500 sq. ft. or
portion thereof
$106.00
$ 19.00
Each Ma~b1ct'd Home or
MN.Qitj~~:lIing Service or
FtlmS PERMIT SHALL EXPIRi-If T~~O
B.
20AN."MO 100Y PERIOD.
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsN olts
Reconnect Only
/
$ 61,00
$ 75,00
$125.00
$163,00
$375.00
$50,00 ~. 00
c.
Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100,00
Over 6em ~~~;n;nbOd\lolfdee' "B" above.
D.
"-..-":i. ,I.~. J i " ,'} I"
New M\1(ef~t'Q'b~:r:{~~~~~~~~~ ~~f-~~l!-,n!)J'
One <Dii;Qtlit Yeu n1ElY obtain CO~<,' ,$43.00'
Each Ar.lditj'Otlali12ir,cuitor,with, :-'~~; ~","; ~', >::i ':i
'l!J~, ....\..j ,He '~C;' 'lo;l. (''. ~J'",. "'-'l, $ 3'
Service..OI: Fe,~rleF Peoni't' . " ',~' ~,:' v,,:: ,; .00' ,C;
m:.rmuc;l lOr lflO U"''1nn "'" 'I '
I ..., : \,..;~~.. U~lJI~',/ :\C':L
E.
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50,00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4.
!;() .00
3.~o
S-:OD
Sl.SV
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building Forms/Electrical Permit Application I-03.doc
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2005-01621
ISSUED: 11/17/2005
APPLIED: 11/17/2005
EXPIRES: 05/17/2006
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 612 CENTENNIAL BLVD
ASSESSOR'S PARCEL NO.: 1703264311100
Springfield TYPE OF WORK: Electrical Work Only
TYPE OF USE: Repair
Residential
PROJECT DESCRIPTION: Reconnect Only.
Owner:
Address:
TUHY LOYD W & LINDA L
612 CENTENNIAL BLVD
SPRINGFIELD OR 97477
Contractor Type
Electrical
Contractor
ALERT ELECTRIC INC
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AU' HUKILtU UI~[)i:~ -;1110 rem.1lT I~ WE
CONTRACTO ION I " ABANDONED FOR
ANY 180 DAY D.
License Expiration Date
12772 OS/22/2007
Phone
541-747-2213
BUILDING INFORMATION I
,,#ofUnits:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path: ___ ,_ __ ,
i\ < .' \1' ,1\1, r-'\ "I-:','-J"I' '
SprinkJed Building:; "" I'. .-' 'n/a , '
.r-f""'I!1,,"",'d tJ 11,_~ ':~ -:_..... ~ ,...-, '\
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
I ' ,
Occupant Load:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
, Solar Setbacks:
I DEVELOPMEN1HNFORMA.tfIONi't ~i:.:~2 ,;~~',~r;' " r'
In Vi'\I\ 0;J;.:-GU, -'"u i \., II II Cl,~I, ,) : REQUIRED PARKING
Y 1 ',' ..., ...-, ,,' 1-_""",,\ ,:C 1_\/
O nqso. OL! ma~f OOl21,l CO:~k,c wl,I,~ c':~" J
verlay DfSt. " ," .. (: I _'~. ",.0 "":::rota1.",,
# St t T r.~R.I~GG Lila cemsr. ,", lAG. ',' '~~'H',")' ,Jd,., ~ d'
ree rees- ~u. . . "" U""!" I ,aQ lcanpe .
P d D. 'Rij"'tl,"'a( Wi' Ills ,-,reOOil' LI :,y ,,"0, C'!'I\",-",urt
ave rive :J~ <=l ,ompact:
C ' . .' 800 "32 )3 "i')
% of Lot Coverage: snL8r IS 1- .0 _ - _ L,., .
I PUBLIC IMPROVEMENTS I
.' Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrains:
Notes:
I Valuation Description I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Pa2e 1 of2
~
:-:-$PFI,',',,',N, "QF'I,tE, ,L.O~,.'."",.',,'.' '>['",....
' WtL.,J,j - i
,..,,...."
._ ___"~_C_."_..'.~"._.._ ,~_. .. ... .. "..... " ,
Status
Issued
CITY OF SPRINGf11ELU .
Building/Combination Permit
PERMIT NO: COM2005-01621
ISSUED: 11/17/2005
APPLIED: 11/17/2005
EXPIRES: 05/17/2006
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
LFees Paid'
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Service Reconnect
Amount Paid
Date Paid
Receipt Number
$5.00
$3.50
$50.00
11/17/05
11/17/05
11/17/05
2200500000000001594
2200500000000001594
2200500000000001594
Total Amount Paid
$58.50
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
I Reouired Insoections I
Electric Service: Approval required prior to utility company energizing service.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
times during construction.
Owner or Contractors Signature
Date
Pa2e 2 of2
'225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2005-0 1621
COM2005-0 1621
COM2005-01621
Payments:
Type of Payment
CreditCard,
),
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11/17/2005
RECEIPT #:
Description
Service Reconnect
+ 7% State Surcharge '
+ 10% Administrative Fee
Paid By
ALERT ELECTRIC
"'~ty of Springfield Official Receipt " '
, .:velopment Services Department
Public Works Department
2200500000000001594
Date: 11/17/2005
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
ddk 017872 In Pe'rson
Payment Total:
Page 1 of 1
1:24:55PM
Amount Due
50.00
3.50
5.00
$58.50
Amount Paid
$58.50
$58.50
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